Lewis - PICC around the world

(1)

Rich Lewis,

RN

,

BS

,

V

A

-BC

Global

Business

Manager

-

Europe

Bard

Ac

cess

Systems

(2)

E

st

Nu

rs

ing Placer P

r

o

gr

a

m

s

Locations Where Nurses Have Been

(3)

E

st

Nu

rs

ing Placer P

r

o

gr

a

m

s

N

ew

and

lim

ited

P

r

o

gr

a

m

s

Locations Where Nurses Have Been

(4)

Brazil

n

 

Population

199 M

1 (2012)

n

 

Universal Unified

2 He

al

thcare system

- S

U

S

(1

9

8

8 )

is

a pub

l

ic system

avai

l

able to

all

c

i

t

i

zens

n

6,706

hospitals,

480,332

beds

(2014)

n 

Ratio

of doctors per 1000

patients

(2011)

n  1.95 MD’s in the public system n  7.6 MD’s in the private

n 

Healthcare

expenditure 4.7%

GD

P

3 (2013)

1 _{The World Data Bank; World Development Indicators, Population 2012}

(5)

• PICCs are placed in Brazil by:

• Nurses

• Vascular surgeons

• Intensivists

• Interventional Radiologists

• PICCs are place in Brazil for:

• Antibiotics

• Nutrition

• Oncology

• ICU

Brazil

(6)

Brazil

n

 

C

l

i

n

ical Practice

1 n

 

It

is

with

i

n

t

h

e sc

o

pe of

practice

f

o

r

n

urses

to

place

PICCs

n

 

Ultrasound

n

 

MST

n

 

At

one

hospital,

n

urses

can

requ

e

st

a

P

ICC

using

a

decisi

o

n

alg

o

rithm

n

 

Few

ded

icated

VAD

teams

(7)

Co

l

ombia

n

 

Population 48M

1 (2012)

n

 

96%

have

access

to

healthcar

e

2 (20

1 4)

n

 

95%

of the

pop

u

lation

li

v

es

i

n

h

alf of

the

country

2 (20

1 4)

n

 

Colombia Hospital beds: 1.1 per

1,000 people

n

 

Physicians: 1.35 per 1,000 people

n

 

Life expectancy : 72.81 years

n

 

Healthcare expenditure 5.2% GDP

3 (2013)

(8)

Co

l

ombia

n

 

C

l

i

n

ical Practice

1 n

 

PICCs are available in Colombia--

mixed perception

n

 

Mostly lower arm placement

n

 

Limited use of Ultrasound or MST

n

 

R

a

d

i

ologists

p

l

ace

using

n

 

US

n

 

Fluoroscopy

n

 

MST

(9)

Japan

n 

Population

128MM

1 (2012)

n 

Everyone

is

required to be insured

2 (2014)

n 

Employer-based

plans cover approx

60%

of the

population

n 

40%

covered through government plans

n 

Patient

co-pay

req’d for 30%

of healthcare

cost

n 

2nd largest

healthcare

economy

in

the

world

n 

2,600

hospitals

with

200+

beds

n 

Shortage

of both doctors and

nurses

n 

Gov’t

promoting:

n 

Use of high tech medical devices

n 

Changing

payment structures

n 

Attempting

to reduce length of stay

n 

Healthcare

expenditure 8.5%

GD

P

3 (2013)

2 _{Data collected by Bard Access Systems during Japan internal review 2014. Bard Access Systems internal} data only.

(10)

Japan

n

 

PI

C

p

l

acement

is

nearly

10

0 %

p

h

ysician

s

1 n

 

PI

C

p

l

acement

is

not domi

n

ated

by

any

one

specialty

1 n

 

Very

few cl

i

nic

i

ans

p

erform

a

hi

g

h

nu

m

ber

of

VAD

p

lacements

1 n

 

IV

antibiotic are

n

ot routinely

de

l

i

v

ered

through

PI

C

Cs

–

using

PIV

s

1 n

 

VAD

choice is based

on p

h

ysician

preference

and

experienc

e

1

(11)

Saudi

Arabia

n

 

Population:

28 M

M

1 (20

1 2)

n

 

Age

breakdow

n

2 (

2014)

n

0-14 years—27

.6%

n

15-64 years—69.2%

n

 

65 years and over—3.2%

n

 

Total

expenditure

o

n heal

t

h

2.0%

GD

P

3 ₍₂₀₁₃₎

n

 

Healthcare syste

m

2 (2014)

n

Public--(60%)

n

 

Central/State Govt./Military--(20%)

n

 

Self Pay/Private Insurance—(20%)

n

 

78 International JCI healthcare

facilities

(12)

Saudi

Arabia

n 

PICC

training

is

beginning

to

gain

traction

in

Saud

i

1 n

 

O

ne

t

eam

use

s

an

ad

v

a

n

ced

prac

t

ice

model

n 

Consultants work with physicians to

determine the most appropriate VAD for

the patient

n 

Practice according to ONS guidelines

n 

Incorporate CDC guidelines

n

 

2

nd

t

eam

work

i

ng

un

der

auspices

of c

a

rdi

ology

n 

2 person team

n 

Placing PICCs for post-surgical infections

n 

Work with neonatal to adult patients

n

 

3

rd

t

eam—

nurs

es

w

orki

ng

out

of

i

nterventi

ona

l radi

o

l

ogy

n 

Using ultrasound and fluoroscopy

n 

VAD

s

election,

insertion,

care

& maintenance

is

not

wel

l

understood

out

si

de

of

the

s

e

three

i

n

st

itutio

n

s

(13)

• PICCs are placed in Saudi Arabia by:

• Interventional Radiologists

• Nurses

• PICCs are place in Saudi Arabia for:

• Antibiotics

• Oncology

• Nutrition

Saudi

Arabia

(14)

India

n

 

Population:

1.24 billio

n

1 (2012)

n

 

Healthcare

expenditure 1.3%

GDP

3 (2013)

n

 

Healthcare

syste

m

2 (2015)

n

 

Private

pay--

(14%)

n

 

Self

Pay --

(86%)

(15)

India

n

 

US and

M

ST are

rarely used by

nurses

1 n

 

PIVs are t

h

e device

of

choice f

o

r most IV

thera

p

ies

1

(16)

• PICCs are placed in India by:

• Nurses

• Oncologists

• Vascular Surgeons

• Other

• PICCs are placed in India for:

• Chemotherapy

India

(17)

France

n

 

Placing

PI

C

Cs

/ ports

cu

r

rently

1 outside

the

scope

of

practice

for n

u

rses

n

 

French

govern

m

ent

prov

i

des

pathway

to

allow n

u

rses

and

techs

to p

l

ace

central VADs

n

 

Delegation/transfer of

competency

n

 

Lengthy process & difficult to

qualify

(18)

Sum

m

ary

q

 

The

use

of

PICC

’

s

is

g

r

owing

a

r

ound

the

World

qThe

number

of

c

ount

r

ies

placing

PICCs

is

increas

i

ng

q

I

n some

c

ount

r

ies

wher

e

PICCs

a

r

e

growing,

the

r

ole

of

nurse

and

oth

er

no

n

-p

h

ysician